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WHAT A NURSE SHOULD KNOW ABOUT SYPHILIS 

SALVARSAN 

By Herman Goodman, B.S., M.D. 

New York, N. Y. 

(Continued from page 112) 

As was mentioned in the first article of this series, Ehrlich after 
"606" experiments to produce a drug which has the greatest poison- 
ous action on the cause of syphilis and which at the same time is 
almost harmless to the living tissue of the patient, produced the 
synthetic arsenic preparation to which was given the trade name of 
Salvarsan. The original "606" was manufactured by Farbwerke 
vormals Meister Lucius & Bruning, Hoechst 0. M. Germany. 

Salvarsan is a yellow powder which dissolves with a strongly 
acid reaction in water. If the solution should be injected in the acid 
condition, the life of the patient would be endangered. Hence, it is 
most important for the nurse to remember that if salvarsan, "606," 
or as it is sometimes called, "old salvarsan," is to be used, an alkaline 
solution, fifteen per cent sodium hydroxide, is to be on hand for the 
doctor's use. 

Since the recent war made delivery of German salvarsan un- 
certain, "606" has been manufactured in many other countries. In 
the United States, the generic term of Arsphenamine has been chosen 
to represent the chemical compound of "old salvarsan" or "606." 
Various chemical houses produce and market under license different 
brands of arsphenamine. The nurse should be acquainted with the 
more popular of these. 

The first American-made arsphenamine was sold as Arsenobenzol. 
It was made by the Dermatological Research Laboratories, Phila- 
delphia Polyclinic, 1818 Lombard Street, Philadelphia, U. S. A. This 
drug requires hot water for solution and must be alkalinized with 
sodium hydroxide. 

A Canadian firm, Synthetic Drug Company, produces a compound 
which is called Diarsenol. This drug requires alkalinization. 

A French company sells Arsenobenzol (Billon), and an English 
firm makes Kharsivan. Both these drugs require the use of the 
sodium hydroxide solution. 

The importers of Salvarsan, Farbwerke Hoechst Company of 
New York, organized a laboratory that was supposed to manufacture 
a drug exactly equivalent to the German product. The Arsphenamine 
(Metz and Co.) is marketed as Salvarsan in ampoules, boxes, and 
labels simulating the original. Unfortunately, however, the drug is 
not the same. 

200 



What a Nurse Should Know About Syphilis 201 

As was mentioned further in the first article, Ehrlich did not 
stop with "606" but proceeded with his experiments until "914" or 
Neosalvarsan had been produced. We quote the circular which ac- 
companied the German-made Neosalvarsan : 

By experiments on animals and clinical tests it was proved that this new 
modification of Salvarsan which we are placing on the market under the protected 
name "Neosalvarsan" possesses various advantages over Salvarsan. 

1. Neosalvarsan dissolves very easily in water and gives a solution of com- 
pletely neutral reaction. 

2. Neosalvarsan is better tolerated subjectively. 

3. The activity of Neosalvarsan is at least as great as that of Salvarsan. 

4. Neosalvarsan is suitable for intramuscular injection. 

5. The employment of Neosalvarsan is preferable for patients who exhibit 
hypersensitiveness towards Salvarsan (facial oedema). 

Solutions of Neosalvarsan must on no account be kept or allowed to stand 
but must be injected immediately after their preparation as they oxidize even more 
readily than the solutions of Salvarsan. 

The temperature of the injection fluid should not rise above 20-22C. (68 to 
71.6 F.). All warming of the Neosalvarsan solution must be avoided. 

As with salvarsan, the impossibility of securing German 
neosalvarsan acted as an impetus to other manufacturers and soon 
many brands were available. In the United States, the name Neo- 
Arsphenamine was given to these products. 

The Dermatological Research Laboratories, Philadelphia, U. S. A., 
produce a Neo-arsphenamine which "is identical in all essential re- 
spects with the compound originally prepared by Professor Ehrlich 
under the name of Neo-salvarsan." No alkali is required in the 
preparation of the drug as Neo-arsphenamine is already neutral when 
in solution. Warm or hot water should be avoided. 

A French company issues a Novarsenobenzol (Billon) which is 
sold in the United States and has found favor here. 

The Synthetic Drug Company of Canada manufactures 
Neodiarsenol, distributed by The Diarsenol Company, Toronto, 
Canada. 

The H. A. Metz Laboratories, Inc., New York, manufacture a 
Neoarsphenamine under the trade mark "Neosalvarsan" which 
identifies the substance with the manufacture established under Pro- 
fessor Dr. Paul Ehrlich by Farbwerke, vormals Meister Lucius & 
Brunig, Hoechst 0. M. Germany, and extended to the United States 
by Farbwerke Hoechst Company, New York, N. Y. The package, 
circular, etc., of this product closely resemble the German 
Neosalvarsan which this firm formerly distributed. 

The nurse should remember that Neosalvarsan, "914," or "new 
salvarsan" and Neoarsphenamine do not require alkali, must not be 
heated, and they should not be kept standing before administration. 



202 The American Journal of Nursing 

The doses of salvarsan administered intravenously vary accord- 
ing to the age of the patient and the character of the manifestation. 
The ordinary doses vary from four to six decigrams. The maximum 
dose, six decigrams, should be given only to vigorous individuals, who 
are known to be tolerant to the drug. 

The doses of neosalvarsan are one-half greater than for "old 
salvarsan." The maximum dose for these salts is nine decigrams. 
Different doctors use various formulae in estimating dosage, and the 
frequency of injection. 

In the next article, the nurse's share in the preparation of the 
drug and of the patient for injection will be given. 

(To be continued.) 



TOWNSHIP NURSING IN WESTCHESTER 

COUNTY, N. Y. 

By Lena Coleman, R.N. 

Harrison, N. Y. 

There are no limitations to the duties of the township visiting 
nurse. Now the visiting nurse may or may not be entitled to the 
name of public health nurse, nevertheless there is no branch of public 
health work which the township nurse passes by, for she is called 
upon to aid in all sorts of emergencies from assisting the physicians 
in patching up a patient after he has been gored by a bull, to aiding 
the health officers in combating an influenza epidemic. She is the 
teacher of Little Mothers' League classes for girls, and of Home 
Nursing classes for groups of women. The township nurse is the 
pioneer in her field for she demonstrates the value of school nursing 
and ferrets out the tuberculosis cases and secures the examination of 
contacts. She also paves the way for other nurses in the field. 

The first nurse employed in the village of Harrison, seven years 
ago, was a visiting nurse. Her work led to the employment of a nurse 
for the five public schools of the township, two years ago. Still there 
were sections in the township which needed a visiting nurse, so nine 
months ago the Town of Harrison Nursing Association was formed 
and another visiting nurse was employed. The township was then 
divided into two nursing districts with a visiting nurse in each and a 
school nurse to cover the work of all of the schools in the township. 

With the districting of the township, it has been possible to give 
more attention to the instructive side of the visiting work. True, the 
daily rounds must be made and the first attention given to the care 
of the sick, but there has been more time for preventive work. The